It has been 30 years since that landmark legislation, and we have made tremendous strides in “the war.” No longer is a person diagnosed with cancer served a death sentence. Our understanding of the mechanisms underlying cancers has allowed us to start targeting treatment and separating out a group of diseases that we call “cancer.” Molecular techniques and advances in cell biology gained from cancer research have spilled over into other areas of science such as neuroscience and physiology. Thirty years of research and clinical investigations have given us hope and promise that one day most cancers will be sucessfully treated by the wide variety of new modalities being developed.

The statistics speak for themselves. A report released last year by the NCI, the American Cancer Society, the North American Association of Central Cancer Registries, the Centers for Disease Control and Prevention, and the National Center for Health Statistics reported a general decrease of 0.8 percent per year in the incidence rate for all cancers combined from 1990 to 1997. The greatest decline in cancer incidence rates has been among men, who overall have higher rates of cancer than women. There is reason for hope. While breast cancer incidence rates showed little change in the 1990s, breast cancer death rates have declined about 2 percent per year since 1990 and have dropped sharply since 1995.

With the growing use of electronic media, information is readily available to more and more individuals. Although these media allow for rapid distribution of information, there is no assurance that the information provided is accurate and scientifically sound. Members of the public have many questions when they have cancer, and they don’t understand why one person develops cancer and another person doesn’t. They have questions about how their environment may have contributed to the development of their disease. The scientific community doesn’t have all the answers, but we assembled a group of researchers to discuss some of these questions.

As part of its task, the Roundtable convenes workshops to inform the debate on issues related to environmental health. We continue to explore the impact that the environment has on our cities, our families, and our health. It shouldn’t be surprising to anyone that the places in which we work, eat, sleep, and play can have a dramatic impact on our health. As I have said many times, “Environmental laws are more than regulations—they are health laws!”

In September 2000, the Roundtable decided to convene a workshop on Cancer and the Environment: Gene–Environment Interactions on May 16–17, 2001. During the planning, it became clear that a two-day meeting would start the process but would still leave many questions unanswered. What is clear, however, is that understanding the role of cancer and the environment is one of the greatest challenges that we face in this new century.

As you can read in later sections of this report, there are significant differences in populations and the development of cancer. We have a significant vulnerable population that includes children, minorities, women, and the poor. We

Front Matter (R1-R20)

Summary (1-6)

1. Charge to Participants and Workshop Objectives (7-10)

2. Keynote Addresses (11-24)

3. The Links between Environmental Factors, Genetics, and the Development of Cancer (25-35)

4. Gene-Environment Interaction in Special Populations (36-45)

5. Gene-Environment Interaction in Site-specific Cancers (46-59)

6. Special Address: A Novel Approach to Cancer Treatment Based on Immune Stimulations and Other Environmental Approaches (60-62)

7. Cancer and the Environment: A View from the Hill (63-64)

8. Moving Forward (65-69)

Abstracts of Talks (70-107)

References (108-118)

Appendix A Glossary (119-122)

Appendix B Workshop Agenda (123-127)

Appendix C Speakers and Panelists (128-130)

Appendix D Workshop Participants (131-140)